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Asthma is defined as a chronic inflammatory disorder of the airways, with severe asthma causing inflammation that is harder to treat1,2

  • Asthma related chronic inflammation is associated with airway hyperresponsiveness that leads to recurrent symptoms of wheezing, breathlessness, chest tightness and coughing1
  • Symptoms are often associated with widespread or variable airflow obstruction within the lung that is often reversible either spontaneously or with treatment options1
  • Severe asthma refers to asthma which does not get better with the usual treatment leaving patients with breathing problems most of the time, meaning that a different treatment approach may be necessary to control the symptoms3,4

Potential severe asthma triggers

Certain triggers of asthma may lead to the development and worsening of severe asthma symptoms5,6

 

Common asthma triggers include:

Infections

Allergies

Smoke, fumes and pollution

Medicines

Emotions

Weather changes

Mould or damp

Exercise

Considerations of comorbidities with severe asthma

  • The majority of patients with severe asthma present with comorbidities, which can include chronic rhinosinusitis, nasal polyposis and allergic rhinitis6,7
  • Identifying other comorbidities are important in the management of severe asthma, as they may contribute to poor disease control leading to symptom aggravation, as well as mimicking symptoms7
  • Severe asthma is a complex and heterogeneous disease that should be treated with a personalised approach therefore, appropriate diagnosis and management of severe asthma is critical6

DUPIXENT is the first
biologic for the treatment
of severe asthma to inhibit signalling of Type 2 cytokines, IL-4 and IL-138

DUPIXENT is indicated in adults and adolescents 12 years and older as add-on maintenance treatment for severe asthma with Type 2 inflammation characterised by:8

  • raised blood eosinophils (EOS)
  • and/or raised fraction of exhaled nitric oxide (FeNO)
  • who are inadequately controlled with high-dose inhaled corticosteroids (ICS) plus another medicinal product for maintenance treatment

Challenge of severe asthma

Patients with severe asthma risk premature mortality and corticosteroid-related morbidities3,4,9,10

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Complexity of Type 2 inflammation

No single biomarker fully captures the complexity of Type 2 inflammation in asthma11–16

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Severe asthma: Mode of disease

IL-4 and IL-13 are key drivers of Type 2 inflammation in severe asthma11,12,17,18

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EOS, eosinophils; FeNO, fractional exhaled nitric oxide; ILC, innate lymphoid cells; IL, interleukin; IgE, Immunoglobulin E; OCS, oral corticosteroids; Th, t-helper.

References

  1. Cukic V, et al. Mater Sociomed. 2012;24(2):100–105.
  2. American Lung Association. Severe asthma. Available at: https://www.lung.org/lung-health-diseases/lung-disease-lookup/asthma/learn-about-asthma/severe-asthma. Date accessed: November 2021.
  3. Asthma UK. What is severe asthma? Available at: https://www.asthma.org.uk/advice/severe-asthma/what-is-severe-asthma/. Date accessed: November 2021.
  4. Asthma UK. Severe asthma: the unmet need and the global challenge. Available at: https://www.asthma.org.uk/globalassets/get-involved/external-affairs-campaignspublications/severe-asthma-report/auk_severeasthma_2017.pdf. Date accessed: November 2021.
  5. NHS UK. Asthma causes. Available at: https://www.nhs.uk/conditions/asthma/causes/. Date accessed: November 2021.
  6. Jones TL, et al. Clin Med (Lond). 2018;18(Suppl2):s36–s40.
  7. Porsbjerg C and Menzies-Gow. Respirology. 2017;22(4):651–61.
  8. Sanofi Genzyme. Dupixent Summary of Product Characteristics, September 2021.
  9. Sweeney J, et al. Thorax. 2016;71(4):339–346.
  10. Why asthma still kills. The National Review of Asthma Deaths (NRAD). May 2014. Available at: https://www.rcplondon.ac.uk/projects/outputs/why-asthma-still-kills. Date accessed: November 2021.
  11. Seys SF, et al. Respir Res. 2017;18:39.
  12. Peters MC, et al. J Allergy Clin Immunol. 2014;133(2):388–394.
  13. Peters MC, et al. J Allergy Clin Immunol. 2019;143(1):104–113.e14.
  14. GINA. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2020. Available at: https://ginasthma.org/wp-content/uploads/2020/06/GINA-2020-report_20_06_04-1-wms.pdf. Date accessed: November 2021.
  15. Amaral R, et al. Clin Transl Allergy. 2018;8:13.
  16. Silkoff PE, et al. J Allergy Clin Immunol. 2017;140(3):710–719.
  17. Tran TN, et al. Ann Allergy Asthma Immunol. 2016;116(1):37–42.
  18. Doran E, et al. Front Med. 2017;4:139.